1 / 17

An Organizational Model of Transformational Change in Health Care P2 Evaluation Team

An Organizational Model of Transformational Change in Health Care P2 Evaluation Team Martin P. Charns , DBA 1,4 Alan B. Cohen , ScD 3,4 Irene E. Cramer , PhD, MSSA 1,4 Sally K. Holmes , MBA 1,4 Mark Meterko , PhD 1,4 Joseph Restuccia , DrPH 2,4

kynan
Télécharger la présentation

An Organizational Model of Transformational Change in Health Care P2 Evaluation Team

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. An Organizational Model of Transformational Change in Health Care P2 Evaluation Team Martin P. Charns, DBA1,4Alan B. Cohen, ScD3,4 Irene E. Cramer, PhD, MSSA1,4Sally K. Holmes, MBA1,4 Mark Meterko, PhD1,4Joseph Restuccia, DrPH2,4 Michael Shwartz, PhD2,4Carol VanDeusen Lukas, EdD1,4 1Boston University School of Public Health 2Boston University School of Management 3Boston University Health Policy Institute 4VA Center for Organization, Leadership & Management Research

  2. The RWJF Pursuing Perfection Program (P2) • IOM Reports (To Err is Human & Crossing the Quality Chasm) created urgency to address patient quality & safety issues. • In response, the Robert Wood Johnson Foundation funded 7 organizations to transform patient care through quality improvement – pursue “perfect care”… • Institute for Healthcare Improvement (IHI) was the national program office for P2 • A Boston University/VA research team was selected to evaluate grantees’ progress.

  3. Qualitative methods Site visits began in 2002 and were completed in 2005. Included all 7 funded sites and 5 “comparison sites” Respondents ranged from C-suite to frontline clinical staff Visits were every 3-6 months N = >750 one-hour interviewsessions Quantitative methods Staff survey conducted in 2004 and 2006. Eight of 12 study sites participated Survey instrument explored perceptions about organizational priorities, values, behaviors & outcomes Survey measures changes over time at respondent level N = >4000 Hybrid Evaluation Design

  4. P2 Strategy for Change • Utilize process improvement • PDSA Cycles • Measurement • Start with 2 projects • Spread to 5 more • Spread to rest of organization • Spread to other institutions

  5. Early in P2 we learned that: • “2 to 5 to all” strategy didn’t work • An organization can do 100 improvement projects successfully & not achieve organizational transformation • Challenge is to spread & sustain the innovations, new values, skills, expectations • Perfect care requires major organizational investment in culture, infrastructure, new management structures & processes to succeed

  6. Organizational TransformationModel

  7. Five critical elements drive change… • Transformation begins with a sense of urgency • Leadershipdrives and facilitates change • Improvement initiatives engage multi-disciplinary front-line staff in meaningful problem solving • To maximize effectiveness, organizations align & integrate efforts

  8. … through the organization • Mission, vision & strategies that set its direction and priorities • Culture that reflects its values and norms • Organizational functions and processes that embody the work that is done in patient care • Infrastructure (e.g., IT, HR, fiscal, facilities management) support the delivery of patient care

  9. Transformation begins with a sense of urgency • Impetus = creating and maintaining a sense of urgency to overcome inertia & fear of change • External pressuresbring urgency • Crossing the Quality Chasm,CMS, AHRQ, Joint Commission) • P2 grantee status & visibility • Internal events & changes can create urgency • Sentinel events & benchmarking data highlight quality problems • New leadership

  10. Leadership drives & facilitates change • Leadership = Board, C-suite, administrative & clinical, formal & informal leaders – but starts at the top • Commitment to & passion for quality improvement • Constancy of purpose; unrelenting pursuit of goals • “Walks the talk” • Invests own time in quality activities • Translate commitment into action • Gets the right people “on & off the bus” • Communicates & builds relationships • Holds staff & teams accountable • Provides resources & infrastructure for improving quality • Fosters learning • Facilitates a well organized & well run effort

  11. Improvement initiatives engage multi-disciplinary staff in meaningful problem solving • Impact desired performance • System re-design to build evidence-based practices into daily work • Micro-level: effectively address frontline quality & safety issues (surgical infection prevention) • Macro-level: fundamentally change how care is delivered (flow projects, chronic care models, EMR implementation) • Build skills, motivation and culture to support and sustain quality improvement • Actively engage staff around priority clinical issue • Collaborative, interdisciplinary work, including MDs • Build staff knowledge & confidence in making improvement • Create momentum for spread

  12. Alignment achieves consistency of goals with actions & resource allocation across the organization • Managing the “vertical” = consistent organizational vision, values & behavior from top to bottom • Alignment is strategic & operational • Improving quality is top priority; support, resources & rewards are aligned accordingly • Improvement projects aligned with strategy & organizational goals throughout the organization • E.g., Mechanisms • Cabinet champion for improvement initiatives • Cascaded improvement priorities • Accountability & performance evaluation down to individual • Resource allocation, rewards, recognition

  13. Integration bridges traditional intra-organizational boundaries between individual components • Managing the “horizontal” = consistency and coordination across the organization(s) • Improving coordination of patient care • Integrating across improvement initiatives • Breaking down silos across departments & workgroups; organizational units (i.e., physician offices, other organizations) • Building system-level performance • E.g., Mechanisms • Collaboratives • Steering committees or quality management oversight structures committees • Matrixed organizational structures (e.g., service lines) • Cross-function management

  14. Dynamic interaction among elements and the organization builds to transformation QI initiatives are cornerstones of organizational change – if they are aligned with organizational priorities • Improvement becomes part of organizational fabric – “the way we work” • QI initiatives drive change in IT and HR which in turn support spread and further change • Organizations develop infrastructure to support the new way of functioning • Infrastructure is the glue that cements the changes

  15. Organizational TransformationModel

  16. Conclusions: Building Change Over Time • Organizational transformation requires addressing all key model elements • Fundamental organization change takes more than 5 years • Permanent, organization-wide change builds iteratively • Redesigning care & implementation involve multiple, iterative cycles • Change is non-linear – “two steps forward & one back “ • Failures are instructive • “The goalpost keeps moving…the more we improve, the more there is to do…”

  17. Lukas, C.V., Holmes, S.K., Cohen, A.B., Restuccia, J., Cramer, I.E, Shwartz, M., Charns M.P. (2007). An organizational model of transformational change in healthcare systems. Health Care Management Review, 32(4): 309-320.

More Related